Managing Nail Infections

By Dr. Yves Poulin, MD, FRCPC

What is Onychomycosis?

Onychomycosis is an infection of the toe nails or finger nails by fungi. It can be very uncomfortable, even painful and embarrassing. The most common spot is the toenail, especially the big toe.

It is very uncommon to have an infection of the fingernails without also having your toenails infected. For complete information, go to www.fungalguide.ca

Who's at Risk to Get a Nail Infection?

• advanced age
• diabetes
• peripheral vascular disease
• immunosuppression
• trauma to nails (e.g., runners often experience nail trauma - this should not be confused with nail dystrophy of runners)
• occupations requiring occlusive foot wear.
• More common in adults, very uncommon in children.

Although nail changes may be due to various causes, a fungal invasion is found in more than 50% of cases. Other causes include trauma to the nail or psoriasis.

What to Look For

• Your nail is discolored on the surface or under the nail including white "chalkiness"
• Your nail has thickened or appears crumbly
• There is a collection of blood under the nail (Subungual haemorrhage)
• Onycholysis: meaning that your nail has separated or loosened from the nail bed (See below for other possible causes of this)

Causes of Onycholysis (Nail Separation)

• Psoriasis (Read more on www.psoriasisguide.ca/basics/types/types_of_psoriasis.html )
• Trauma
• Hyperhidrosis
• Eczema
• Chemical (e.g., solvents, nail hardeners)
• Drug-induced: ie/ photo-onycholysis (with doxicycline and other photosensitizers) or chemotherapy.
• Impaired peripheral circulation
• Systemic disorders like hypo- and hyperthyroidism.
• Idiopathic
• Onychomycosis

How Onychomycosis is Diagnosed?

Your doctor may confirm the clinical diagnosis by having a KOH examination of nail scrapings or fungal culture.

Treating Onychomycosis

There are a variety of options to treat your nail infection depending on the severity of your condition as well as other underlying factors that may influence the treatment. Treatments come in different forms, each with its own risks and benefits associated with them.

• Topical creams ie/ Loprox®
• Nail lacquer: ie/ Penlac®
• Systemic drugs ie/ Lamisil® , Sporanox®

Before starting any treatment, you need to discuss risks and possible complications with your physician. You need to be patient with the treatment as it can take months. The possibility of your onychomycosis recurring, even after it is completely cured, is also a problem.

About the author:
Dr. Poulin is Assistant Clinical Professor in the Department of Medicine, dermatology service at Laval University in Quebec City. He is President of the Quebec Dermatology Society and Coordinator of the Education Committee of the Quebec Dermatology Association. Dr. Poulin has authored a number of articles for international medical journals.

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